Provider Demographics
NPI:1740310614
Name:RABUN MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:RABUN MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M.
Authorized Official - Middle Name:KATHY
Authorized Official - Last Name:EASTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-782-0468
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-0023
Mailing Address - Country:US
Mailing Address - Phone:706-782-0468
Mailing Address - Fax:706-782-1488
Practice Address - Street 1:773 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4257
Practice Address - Country:US
Practice Address - Phone:706-782-0468
Practice Address - Fax:706-782-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051960207R00000X, 208D00000X
GA027807208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA716351517AMedicaid
GRP6972Medicare PIN